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Complicated grief

Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward.

For some people, feelings of loss are debilitating and don't improve even after time passes. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble accepting the loss and resuming your own life.

Different people follow different paths through the grieving experience. The order and timing of these phases may vary from person to person:

Accepting the reality of your loss

Allowing yourself to experience the pain of your loss

Adjusting to a new reality in which the deceased is no longer present

Having other relationships

These differences are normal. But if you're unable to move through one or more of these stages after a considerable amount of time, you may have complicated grief. If so, seek treatment. It can help you come to terms with your loss and reclaim a sense of acceptance and peace.

Symptoms
Causes
Risk factors
Complications
Prevention

During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade over time, those of complicated grief linger or get worse. Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing.

Signs and symptoms of complicated grief may include:

Intense sorrow and pain at the thought of your loved one

Focus on little else but your loved one's death

Extreme focus on reminders of the loved one or excessive avoidance of reminders

Intense and persistent longing or pining for the deceased

Problems accepting the death

Numbness or detachment

Bitterness about your loss

Feeling that life holds no meaning or purpose

Irritability or agitation

Lack of trust in others

Inability to enjoy life or think back on positive experiences with your loved one

When to see a doctor

Call your doctor if you've recently lost a loved one and feel such profound disbelief, hopelessness or intense yearning for your loved one that you can't function in daily life, or if intense grief doesn't improve over time.

Specifically, you may benefit from professional help if, over time, you continue to:

Have trouble carrying out normal routines

Withdraw from social activities

Experience depression or deep sadness

Have thoughts of guilt or self-blame

Believe that you did something wrong or could have prevented the death

Have lost your sense of purpose in life

Feel life isn't worth living without your loved one

Wish you had died along with your loved one

If you have thoughts of suicide

At times, people with complicated grief may consider suicide. If you're thinking about suicide, talk to someone you trust. If you think you may act on suicidal feelings, call 911 or your local emergency services number right away. Or call a suicide hotline number. In the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.

Related

You may start by contacting your doctor. After your initial appointment, your doctor may refer you to a mental health provider who can help diagnose your symptoms and provide a treatment plan.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

Any symptoms you've been experiencing and for how long. Your doctor will want to know the extent to which these symptoms are affecting your daily life, including work and personal relationships.

Your key personal information, especially any additional major stress or change you've experienced since your loved one died, such as serious illness, significant family disruptions or financial problems.

Medical information, including other physical or mental health conditions with which you've been diagnosed.

All medications,vitamins or other supplements you're taking and the dosages.

Questions you'd like to ask your doctor.

You may want to ask a trusted family member or friend to be present for your appointment, if possible, to help you remember key information.

The normal process of grieving can become complicated grief when your symptoms show no signs of improvement over time.

Grieving is a highly individual process for each person, and determining when normal grief becomes complicated grief can be difficult. There's currently no consensus among mental health experts about how much time must pass before complicated grief can be diagnosed.

Complicated grief may be considered when the intensity of grief has not decreased in the months following your loved one's death. Some mental health professionals diagnose complicated grief when grieving continues to be intense, persistent and debilitating beyond six months.

There are many similarities between complicated grief and major depression, but there are also distinct differences. In some cases, clinical depression and complicated grief occur together. Getting the correct diagnosis is essential for appropriate treatment.

Your mental health professional may consider you to have complicated grief based on these criteria. You experience:

Your doctor or mental health provider will determine what treatment is likely to work best for you based on your particular symptoms and circumstances.

Psychotherapy

Complicated grief is sometimes treated with a type of psychological counseling (psychotherapy) called complicated grief therapy. It's similar to psychotherapy techniques used for post-traumatic stress disorder (PTSD). Other counseling approaches also may be effective.

Hold imagined conversations with your loved one and retell the circumstances of the death to help you become less distressed by images and thoughts of your loved one

Explore and process emotions

Improve coping skills

Reduce feelings of blame and guilt

Medications

There's little solid research on the use of psychiatric medications to treat complicated grief. However, antidepressants may be helpful in people who have clinical depression as well as complicated grief.

Exercise regularly. Physical exercise helps relieve depression, stress and anxiety and can redirect your mind to the activity at hand.

Take care of yourself. Get enough rest, eat a healthy diet and take time to relax. Don't turn to alcohol or illegal drugs for relief.

Reach out to your faith community. If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.

Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.

Socialize. Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.

Plan ahead for special dates or anniversaries. Holidays, anniversaries and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate or acknowledge your loved one that provide you comfort and hope.

Learn new skills. If you were highly dependent on your loved one, for example, to handle the cooking or finances, try to master these tasks yourself. Ask family, friends or professionals for guidance, if necessary. Seek out community classes and resources, too.

Join a support group. You may not be ready to join a support group immediately after your loss, but over time you may find shared experiences comforting and you may form meaningful new relationships.